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Boards Questions n Shit Flashcards

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1
Q

Immune response for hyperacute transplant rejection?

A
  • rejection within minutes

- Type 2 (preformed antibodies)

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2
Q

Immune response for acute transplant rejection?

A
  • weeks
  • t cells recognize foreign MCH molecules
  • type IV
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3
Q

Immune response for chronic transplant rejection?

A
  • months to years
  • t cells think foreign MCHs are self MCHs presenting as non-self antigens
  • type IV
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4
Q

Treatment for digoxin toxicity?

A
  1. normalize serum K and Mg
  2. anti-digoxin Abs
  3. decrease HR with Atropine
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5
Q

What infections should you use vancomycin for?

A
  • MRSA
  • resistant Entercocci
  • C. diff (second line, metronidazole is 1st, ORAL vance)
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6
Q

How does vancomycin resistance develop?

A

-Vanco inhibits cell wall synthesis. binds to D-ala D-ala
-To become resistant, bugs change binding site to D-ala
d-LAC, vance can’t bind to this site on the bug (needs D-ala D-ala)

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7
Q

Positive symptoms of schizophrenia?

A

abnormal things being ADDED (+)

-delusions, hallucinations, delusional speech/behavior,

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8
Q

Negative symptoms of schizophrenia?

A

SUBTRACTING (-) normal things from patients personality

-social withdrawal, no motivation, flat affect, decreased speech/thought

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9
Q

Do atypical antipsychotics treat negative or positive symptoms of schizophrenia?

A
  • POSITIVE, easier to remove a positive symptom than to “restore” a lost negative symptom
  • MOA usually block D2 dopamine receptor
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10
Q

What makes up bone matrix?

A

30% organic- collagen, sulfate, hyaluronic acid
70% crystalline salts- calcium, phosphate, hydroxyapatite (Mg, Na, K, carbonate, strontium, lead, gold, uranium, plutonium all conjugated to hydroxyapatite)

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11
Q

Thiazide and loop diuretics relationship with potassium is…..

A

they excrete K

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12
Q

What diuretics are potassium sparing?

A

Potassium takes a SEAT
Spironolactone
Eplerenone
(both block aldosterone receptors, aldosterone reabsorb Na, excrete K–> these drugs BLOCK THIS)
Amiloride
Triamterene
(both block Na channels in collecting tubule; stop reabsorbing Na= stop extorting K= K stays in body!)

Spironolactone is an androgen receptor antagonist (gynecomastia) and progesterone agonist (menstrual irregularities)

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13
Q

How does Nitroglycerin work when given for an acute MI?

A

DILATES PERIPHERAL VEINS (NOT coronary arteries)

-decreases preload, decreases O2

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14
Q

How does Hydralazine function when given for acute MI?

A
  • Dilates arteries

- increases cAMP in vascular smooth muscle, increases smooth muscle RELAXATION

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15
Q

Risk factors associated with forming cholesterol gallstones?

A 
4 Fs: 
Fat 
Fertile (pregnancy) 
Females 
over 40
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16
Q

Risk factors associated with forming pigment gallstones?

A

chronic hemolysis, alcoholic cirrhosis, elderly, biliary infection

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17
Q

What is internuclear ophthalmoplegia?

A

“MLF syndrome” (seen in MS patients)

  • Lesion of MLF
  • Patient will be looking AWAY from lesion, ipsilateral medial rectus is weak, nystagmus will be seen in OTHER eye
  • BUT….when testing convergence with finger to nose, medial rectus works FINE, only see a problem with lateral gaze.
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18
Q

What is a case control study?

A
  • retrospective
  • group with disease vs group w/o disease
  • calculate odds ratio
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19
Q

What is a cohort study?

A
  • usually prospective
  • start with a known risk factor and see if the group develops the disease
  • calculate relative risk
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20
Q

What is a clinical trial?

A
  • prospective AND experimental
  • compare outcomes of 2 treatments (treatment vs placebo)
  • no risk ratio or odds ratio to calculate
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21
Q

T cells are found ___________

A

in the paracortex of the lymph node, between the follicles and the medulla

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22
Q

Which cytokines are secreted by Th1 cells? (helper 1 T cells)

A

Th1–> IL-2, IFN-gamma

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23
Q

Which cytokines are secreted by Th2 cells? (helper 2 T cells)

A

Th2–> IL-4, IL-6, IL-10, IL-13

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24
Q

On exam infant shows clitoromegaly, labial fusion, elevated 17- hydroxyprogesterone. What is the most common form of adrenal hyperplasia? What will the hormone levels be and what are the other clinical s/s?

A

Most common is 21-hydroxylase deficiency

  • decreased aldosterone, decreased cortisol, increased sex hormones
  • S/S: hypotension, volume depletion, hyperkalemia (increased aldosterone), masculine females (bc of increased androgens)
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25
Scopolamine
- antiemetic - anti-Ach - M1 antagonist - patch on skin - for motion sickness and Sea sickness
26
Promethazine
- antiemetic - histamine antagonist - D2 dopamine antagonist
27
Prochlorperazine
- antiemetic - D2 dopamine antagonist - older; not used anymore
28
Metclopramide
- antiemetic - D2 dopamine antagonist - used for diabetic gastroparesis (speeds up GI tract)
29
Ondansetron
- antiemetic - serotonin antagonist (5-HT3 receptor) - nausea with chemo
30
Scrotal exam reveals palpable scrotal protrusion of hernia with valsava maneuver, what type of hernia?
- Inguinal hernia - DIRECT inguinal hernia protrudes through Hesselbach's triangle - enters through a weak point in the fascia of the abdominal wall (Hesselbach triangle)
31
Describe indirect inguinal hernia
protrudes through the inguinal ring and is ultimately the result of the failure of embryonic closure of the internal inguinal ring after the testicle passes through it -Goes through deep and superficial inguinal rings
32
What makes up Hesselbach's triangle?
1. lateral border of rectus abdominus muscle 2. inguinal ligament 3. inferior epigastric artery
33
How does a decrease in renal artery pressure cause an increase in blood pressure?
decrease renal BP = increased renin = increased angiotensin II = increased aldosterone = increased BP Angiotensinogen --> angiotensin I (by RENIN) --> angiotensin II (bye ACE)
34
What are the 3 endogenous androgens in order from most potent to least potent?
DHT > testosterone > androstenedione
35
What is Osler-Weber-Rendu syndrome?
aka: Hereditary hemorrhagic telangectasia - autosomal dominant - high cardia output --> heart failure - telangectasia (of skin and organs) --> bleeding (nose and GI)
36
Whats the fibrous band attached to the testis and scrotum that aids in normal testicular descent? What is this called in females?
testes- gubernaculum | -ovarial ligament and round ligament of the uterus
37
What are the effects of NSAIDs inhibition of PGE2?
NSAIDs inhibit COX--> decrease PGE2 --> increase vasoconstriction, increase bronchoconstrion
38
Effect of prostaglandins and angiotensin II on renal arterioles?
prostaglandins increase vasodilation to kidneys, dilate AFFERENT arterioles, increase GFR angioTENSIN II --> TENSES arterioles - vasoconstriction of efferent artioles --> increase GFR and increase filtration fraction (FF)
39
What organism causes Hansen disease? What animal serves as the reservoir for this organism in the U.S? Where in the body does this organism live?
Hansen Disease= Leprosy Caused by Mycobacterium Leprae Animal in US= Armadillo Lives in coolest parts of body (peripherally); skin and superficial nerves
40
What is BNP, and how is it useful in cases of heart failure?
- B type (brain) natriuretic peptide - Stored in myocytes of ventricles; released when myocytes are excessively stretched - When diastolic P rises; elevated when in heart failure - useful for diagnosis (if pt comes in with SOB and you don't know if they are having COPD exacerbation of CHF, high BNP helps confirm CHF)
41
A 9-year-old child is brought into the clinic for evaluation of a right wrist drop and confusion. Physical exam reveals a bluish line on the gingivae. What peripheral smear finding is consistent with lead poisoning? What is the treatment for lead poisoning in this patient?
Blue lines on gums= LEAD LINES - Basophilic stippling (in RBCs-- built up rRNA bc lead inhibits rRNA; see lots of tiny red dots in RBCs) - EDTA or Succimer (for chelation) - Dimpercaprol + succimer for SEVERE lead intox
42
A 62-year-old man complains of weak urine stream and hesitancy when trying to urinate. His physician prescribes finasteride. How does this agent treat benign prostatic hyperplasia?
Finasteride- Inhibits 5-alpha- reductase; converts testosterone to more potent form of testosterone (dihydrotestosterone) Both make prostate tissue grow, meds stop this process
43
A kidney transplant patient begins to experience renal failure seven years after receiving her kidney transplant. What type of rejection is this, and how is it mediated?
Chronic Rejection- mediated by T cells and antibodies - cause vascular damage - cause obliterative vascular fibrosis
44
What test is used to detect corneal abrasions?
Fluorescein test | looking for pooled areas of fluorescein
45
What physiology accounts for the automaticity of the AV and SA nodes?
Gradually increasing Na channel conductance --> causes slow, spontaneous depolarization of membrane during diastole (filling) --> when threshold is reached, AP is generated
46
What is p value? What is an acceptable p value?
P value: Probability that the study results occurred by chance alone (very small P value, very unlikely that the result occurred only bc of chance) Acceptable P value
47
A patient with an epilepsy diagnosis is pregnant with her first child. She is concerned that her child may also have seizures. What are the most common causes of seizures in children? In adults? In the elderly?
Children: genetic causes, febrile seizures from infection, trauma, metabolic causes Adults: Brain tumors, trauma, stroke, infection Elderly: Stroke, brain tumors, trauma, metabolic causes (hyponatremia), infections
48
Which diuretics lower serum calcium levels? What is the mechanism by which these cause hypocalcemia?
LOOPS LOSE Ca (thaizides retain Ca) Loop diuretics- act in thick ascending limb of loop of henle, inhibit Na-K-Cl co transporter; Ca is absorbed between cells PASSIVELY; if you take a look diuretic and stop the pump, it disrupts to electrochemical gradient and you stop absorbing Ca as well--> Lose Ca in urine
49
What is the difference between a promoter region and an enhancer region?
Promoter- Site on the DNA where RNA polymerase binds (TATA box or CAAT box), upstream from the gene locus itself. Binding PROMOTES gene expression and transcription. Enhancer- Sequence of DNA that ENHANCES gene expression by binding transcription factors (can be located anywhere)
50
What medications are considered first line in the treatment of ADHD?
``` Stimulants: -Methylphenidate (Ritalin, Concerta) -Dextroamphetamine (Adderall) Selective NE reuptake Inhibitor: -Atomoxetine (Strattera) -Use Clonidine for insomnia ```
51
What are the signs of right-sided heart failure? What are the signs of left-sided heart failure? What is most often the cause of right-sided heart failure?
R sided heart failure *systemic problems*- blood backs up into SVC and IVC; JVD, peripheral edema, hepatic congestion L sided heart failure *pulmonary problems*- blood backs up into pulmonary vein/lungs; pulmonary edema (orthopnea), pulmonary HTN, dyspnea on exertion, paroxysmal nocturnal dyspnea (PND) *Most common cause of R sided heart failure is L sided heart failure*
52
What abnormal lab values would lead you to suspect alcoholic hepatitis?
AST > ALT (2:1)
53
How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content?
3- 2 arteries, 1 vein Umbilical vein has highest O2
54
What organisms are particularly known for causing infective endocarditis?
1. Staph aureus 2. Viridans strep (streptococcus mutans) 3. Enterococci 4. Coagulase negative staph (staphylococcus epidermidis) If you think its endocarditis but nothing is growing on cultures think "HACEK" organism - Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella
55
A 60-year-old male long-time patient of yours comes to your office complaining of sexual dysfunction. What is the differential diagnosis? What drugs are known for causing sexual dysfunction?
Differential Diagnosis: -Hormonal disturbances (decreased testosterone, hyperprolactinemia) -Depression -Diabetes -Psych (performance anxiety) -Med side effects (Antihypertensives like beta blockers, neuroleptics, SSRIs for depression, ethanol)
56
A 44-year-old woman is seen in the ER for shortness of breath, malaise, and high fever. Chest x-ray reveals a right-sided consolidation, and her labs reveal a WBC count of 12,000. Which organism is overall the most common cause of lobar pneumonia? What organisms are the most common causes of interstitial (walking) pneumonia?
Lobar (typical pneumonia)- *streptococcus pnemoniae*, staph, H flu, Klebsiella Walking (atypical pneumonia/patchy or interstitial pneumonia)- Mycoplasma pneumoniae, chlamydophila pneumoniae, legionella pneumophila -RSV, adenovirus, influenza (interstitial pneumonia, younger pts)
57
Which type of lymphoma has a presentation that is very similar to CLL and fewer constitutional signs/symptoms?
Small lymphocytic lymphoma (non-hodgkins) -same as CLL, but leukemia is in bone marrow and peripheral blood and lymphoma is in the lymph node
58
A 30-year-old man is at an inpatient facility for opioid addiction. What symptoms might this patient experience while discontinuing opioids?
Tremor, chills, muscle/bone pain, perspiration, flu-like s/s, yawning, vomiting, diarrhea, restless leg syndrome
59
In your own words, describe what type I (alpha) error is
When a study shows a difference between 2 groups, but in reality there is no difference between the 2 groups (Ex: Your study finds that taking aspirin turns your toenails green, but it reality, that doesn't happen when you take aspirin)
60
What trace element is essential to the function of carbonic anhydrase and lactate dehydrogenase?
Zinc (for proper protein folding so enzymes function correctly)
61
A 30-year-old man who is experiencing shortness of breath is diagnosed with obstructive lung disease on pulmonary function testing. The patient does not have a history of asthma and has never smoked. The patient is subsequently diagnosed with α1-antitrypsin deficiency. How does the emphysema caused by smoking differ from the emphysema caused by α1-antitrypsin deficiency?
A1 antitrypsin- inactivates elastase (leads to panacinar emphysema) -->young pt or non smoker Smoking- centriacinar emphysema
62
In what clinical scenarios would you see a “nutmeg” liver?
``` From hepatic congestion due to: -increased central venous pressure -increased resistance to portal flow Seen in: -Right sided heart failure -Budd Chiari syndrome (thrombosis/clot or compression of hepatic vein) ```
63
You are performing a radical mastectomy and exercise extreme caution as you dissect laterally along the serratus anterior muscle. You do this in order to avoid severing which motor nerve, which would result in what sequela?
Long thoracic nerve- damage causes winged scapula
64
A patient comes to the clinic complaining of severe low back pain that radiates down the back of her leg. What is the most likely explanation for her pain?
Herniated IV disc - nucleus pulposis protrudes (usually posteriorly) into vertebral canal, compresses spinal nerve root - L5, S1 (sciatic nerve root) compression causes sciatica down leg
65
What problem/abnormality is associated with calf pseudo hypertrophy?
BUZZ WORD | -Duchenne muscular dystrophy
66
What problem/abnormality is associated with Gower maneuver
BUZZ WORD -Duchenne muscular dystrophy (proximal leg muscle weakness, will see kids using arms and pushing themselves up to get off the ground)
67
What problem/abnormality is associated with subluxation of the lenses
BUZZ WORD | -Marfan syndrome, homocystinuria
68
What problem/abnormality is associated with Café-au-lait spots?
BUZZ WORD | -Neurofibromatosis type 1
69
What problem/abnormality is associated with tuft of hair on lower back?
BUZZ WORD | -spina bifida occulta
70
What type of cell differentiation and maturation takes place at the thymus?
T cell differentiation and maturation Outer cortex- immature cells --> migrate to inner cortex (Medulla) and undergo maturation process -At corticomedullary junction, T cells undergo positive and negative selection to make sure cells are correct
71
The thymus also functions to positively restrict major histocompatibility complex (MHC) at the corticomedullary junction. On which cells would you expect to find MHC I? MHC II?
Positively restrict MCH at corticomedullary junction as well - MCH I: on all nucleated cells - MCH II: on antigen presenting cells
72
A 59-year-old man with a 50-pack-year history of smoking sees you for management of his COPD. What is the clinical definition of chronic bronchitis?
Chronic bronchitis- productive cough for at least 3 months, in at least 2 consecutive years Emphysema (other form of COPD)- permanent enlargement of alveolar air spaces
73
A 50-year-old woman develops a new onset of low back pain without a specific injury. A lumbar x-ray reveals lytic lesions which raise suspicion for multiple myeloma. What is the characteristic finding on electrophoresis with multiple myeloma? What is the classic finding in the urine of a patient with multiple myeloma?
MM- malignant neoplasm of plasma cells that proliferates in the bone marrow; releases local osteolytic factors and causes tons of lytic lesions in bone marrow that you can see on X-ray Electrophoresis- M spike (plasma cells are mature B cells that make antibodies, so you will see a single spike of whatever IG all the neoplastic plasma cells are producing- usually IgG, could be IgA, etc) -Bence-Jones proteins (immunoglobulin light chains found in urine; DON'T see increased normal protein on a regular urine dip stick)
74
What is the mechanism of action of local anesthetics? Which nerve fibers are blocked first with local anesthesia?
Lidocaine- blocks Na channels preventing nerve firing 1) small myelinated fibers blocked first (larger, slower, unmyelinated C type fibers blocked last)
75
What medications are used in the treatment of urge incontinence?
``` Anticholinergics drugs -Oxybutynin -Tolterodine -Darifenacin -Solifenacin -Trospium (DOTTS) ```
76
What are the three different eukaryotic RNA polymerases? What type of RNA does each make?
Prokaryotes have only 1 Eukaryotes have RNA Pol I- makes rRNA RNA Pol II- makes mRNA RNA Pol III- makes tRNA (R.M.T)
77
Which cell types do not require insulin for the uptake of glucose?
*Brain, RBC* | Also intestines, cornea, kidney and liver
78
What are the layers of the epidermis beginning with the most superficial layer? What is Auspitz sign?
``` Come, Lets Get Sun Burned Stratum Corneum Stratum Lucidum Stratum Granulosum Stratum Spinosum Stratum Basale Dermis ``` Auspitz sign- bleeding spots when scales are scraped off (Psoriasis)
79
What is Kallmann syndrome?
- USUALLY sporadic, but can be X-linked familial genetic disease - Usually in males - Caused by defective development of GnRH secreting cels in hypothalamus - Causes low FSH, LH and testosterone - No secondary sexual characteristics - Low sperm count - Anosmia and midline facial defects
80
A 67-year-old man with congestive hear failure lost his job and medical insurance, so he stops buying and taking his digoxin, and develops dyspnea. What will this do to his cardiac output (CO)? What are the mechanisms behind his development of dyspnea?
Digoxin is a + inotrope used for CHF - Increases myocardial contractility and increases CO - Stop meds: decrease CO - -> not pumping enough blood being pumped out from LV --> blood backs up into L atria and pulm vein - -> has pulmonary edema - -> dyspnea
81
A 17-year-old girl is brought to the emergency room for abdominal pain and vomiting. She has a fever, and further questioning and exam reveal that the pain is in the right lower quadrant and has rebound tenderness. She says the pain began around the umbilicus. She is very nauseated and vomits again during the exam. What must be ruled out prior to coming to the final diagnosis in this patient?
Acute appendicitis, pain stars at umbilicus and migrates to McBurneys point MUST CHECK FOR PREGNANCY! -Check beta HCF to rule out ectopic pregnancy
82
A 31-year-old man is post-op day 1 after an exploratory laparotomy. The surgery was performed emergently for intraperitoneal hemorrhage after a motorcycle crash. His creatinine today is elevated to 2.0 mg/dL. His pain is currently uncontrolled. Explain why an NSAID could lead to a potential complication in this patient.
NSAIDS inhibit COX, this blocks prostaglandin formation, prostaglandins dilate blood vessels, if you inhibit this you won't be able to keep the afferent arteriole of glomerulus open, renal plasma flow and GFR will decrease (dangerous to use NSAIDS if you already have decreased renal function)
83
Which phagocyte dysfunction disease increases patient susceptibility to Staphylococcus aureus and Escherichia coli? What is the cause of this disease?
- Chronic granulomatous disease - Cause of this disease is due to a lack of NADPH oxidase - Normally NADPH oxidase allows phagocytes (like neutrophils) to create oxygen free radicals and hydrogen peroxide to KILL BACTERIA in phagolysosomes - Without NADPH oxidase, phagocytes can use hydrogen peroxide from its environment to kill the bacteria, BUT if the bug has a catalase (like staph and e coli), it will decompose the hydrogen peroxide and the phagocyte can't kill it.
84
Does a partial agonist always have a lower maximal efficacy than a full agonist? Does a partial agonist always have a lower potency than a full agonist?
-Maximal effect of a partial agonist is ALWAYS lower than the maximal effect of a full agonist - Potency: how much of the drug/agonist you need to achieve the maximal effect - Potency of a partial agonist can be increased or decreased
85
How is cystic fibrosis diagnosed?
Sweat chloride test (Give Pilocarpine to induce sweating, collect sweat, measure Cl; > 60 on 2 or more occasions) -Genetic testing too -If sweat test isn't working, can test chloride levels of nasal epithelium as back up
86
What are the common causes of metabolic acidosis with an elevated anion gap?
MUD PILES - Methanol - Uremia - Diabetic ketoacidosis - Polyethylene glycol - Iron tablets/ Isoniazid - Lactic acidosis (due to hypotensive shock) - Ethylene glycol - Salicylates (aspirin)
87
You are conducting a study to determine the reduction in risk of developing a relapsing depressive episode with antidepressant X when compared to a placebo treatment. What is this determination called? What is attributable risk, and how is it calculated?
Absolute risk reduction -Attributable Risk= difference in risk between exposed and unexposed groups (risk here: cancer, exposure here: smoking) ``` AR= A/(A+B) - C/(C+D) Ex: # of smokers with cancer/all smokers - # of non smokers with cancer/all non smokers ``` (2x2 square set up)
88
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity- Asthma exacerbation
Type I | occurs rapidly
89
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity- Poison ivy dermatitis
Type IV | T cell mediated
90
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity- Goodpasture syndrome
Type II - Auto-Abs that directly attack the cells - Autoimmune disease that affects kidneys and lungs
91
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity- Arthus reaction
Type III -Immune complex rxn
92
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity- Anaphylaxis
Type I
93
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity- Serum sickness
Type III
94
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity- Autoimmune hemolytic anemia
Type II -Ab binding to Ags on RBCs causing hemolysis
95
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity-  Liver transplant rejection
Type IV
96
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity- Rh incompatibility (erythroblastosis fetalis)
Type II
97
Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity- TB skin test (PPD)
Type IV -delayed HSR (takes days before you can read it; induration, bump filled with T cells)
98
What effect does stress have on adipocytes?
Stress --> Symp activation --> Epi and NE released from adrenal medulla --> Activation of triglyceride lipase in FAT CELLS --> Rapid breakdown of TGs and mobilization of FAs --> used by muscles as energy Stress --> releases corticotropin from ant pituitary --> causes secretion of glucocorticoids from adrenal cortex --> causes activation of HORMONE SENSITIVE triglyceride lipase --> mobilization of FAs used by muscles as energy
99
What is the mechanism of action of leuprolide?
Synthetic GnRH analog -GnRH causes small pulsatile action of anterior pituitary to release small pulses of LH and FSH 1. Leuprolide binds to GnRH receptors in anterior pituitary (just like real GnRBH) 2. Causes anterior pituitary to release LH and FSH for LOOOONG periods of time 3. Eventual down regulation of receptors 4. Suppression of release of LH and FSH 5. Reduced testosterone production (good for treating prostate cancer; slows growth of prostate cancer)
100
A chronic alcoholic with cirrhosis begins to experience a tremor and blurred vision. You suspect that these symptoms might be due to hyperammonemia due to his progressive liver disease. What is another hereditary cause of hyperammonemia? What are some other findings associated with hyperammonemia?
Urea cycle enzyme deficiencies 1. OTC deficiency (Ornithine transcarbamylase deficiency); X linked recessive; show increased ammonia levels first few days of life; will see increased Orotic acid in blood and urine; decreased BUN and neuro s/s Other S/S - tremor - slurred speech - somnolence - vomiting - cerebral edema - blurred vision - NEURO DEFICITS
101
What features distinguish a thyroglossal duct cyst from a branchial cleft cyst? What is the remnant of the thyroglossal duct? Explain the development of the thyroid gland.
- Branchial cleft cyst- lateral neck, does NOT move when swallowing - Thyroglossal duct cyst- midline neck, moves with swallowing; obliterated during development and remnant is foramen cecum Development: Thyroid diverticulum arises from primitive pharynx---> descends into neck beginning at foramen cecum --> thyroid remains connected to tongue by thyroglossal duct --> should go away but if duct persists it becomes the pyramidal love of thyroid
102
A 46-year-old schizophrenic woman has been treated with an atypical antipsychotic with good results for several years. Routine labs reveal a precipitous drop in her WBCs. Which drug is this patient likely taking, and how frequently must her labs be drawn to watch for this problem?
Clozapine- most potent atypical antipsychotics but not used anymore bc it **causes agranulocytosis** Must monitor WBC count weekly!!
103
What class of drugs can be used to treat estrogen receptor-positive breast cancer? What is another use for these drugs? What is the main concern when using tamoxifen?
Selective estrogen receptor modulator - Tamoxifen (can increase risk of endometrial cancer) - Raloxifene - They ANTAGONIZE estrogen receptors in the breast, but act as agonist for estrogen receptors in the bone - Another use: Osteoporosis (especially Raloxifine)
104
How does an anterior shoulder dislocation present differently than a posterior shoulder dislocation? Anterior dislocation arm position vs posterior dislocation arm position:
Ant- External rotation and slight abduction | Post- Internal rotation, adduction, unable to externally rotate the arm
105
How does an anterior shoulder dislocation present differently than a posterior shoulder dislocation? Ant vs Post. neurovascular compromise
Ant- Axillary artery and nerve at risk | Post- unusual to have an neuromuscular compromise
106
How does an anterior shoulder dislocation present differently than a posterior shoulder dislocation? Ant vs post classic scenarios
Ant- blow to the arm while abducted, externally rotated and extended Post- seizure or electrocution (violent muscle contraction yanks bone out of socket)
107
How does an anterior shoulder dislocation present differently than a posterior shoulder dislocation? Ant vs post physical exam
Ant- If thin pt, will see prominent acromion process. Loss of normal roundness of shoulder, appears more angular Post- Bulge in posterior area of shoulder, anterior aspect of the shoulder is relatively flat
108
Which primary bone tumor is associated with the most common malignancy arising within bone?
Multiple myeloma
109
Which primary bone tumor is associated with 11;22 translocation?
Ewing sarcoma
110
Which primary bone tumor is associated with soap-bubble appearance on x-ray?
Giant cell tumor (osteoclastoma)
111
Which primary bone tumor is associated with onion-skin appearance of bone (layers of new bone in periosteum)?
Ewing sarcoma
112
Which primary bone tumor is associated with Codman’s triangle (periosteal elevation) on x-ray?
Osteosarcoma
113
Which primary bone tumor is may arise from osteochondroma or appear as a primary tumor?
Chondrosarcoma
114
Which primary bone tumor is associated with Anaplastic small cells, aggressive mets, good chemo response?
Ewing sarcoma
115
Which primary bone tumor is associated with the most common malignant bone tumor in children?
Osteosarcoma
116
A 45-year-old woman receives a kidney transplant and receives cyclosporine as part of her anti-rejection regimen. What is the mechanism of action of cyclosporine?
Cyclosporine- immunosuppressive used for transplant rejection and some auto immune problems like psoriasis - Binds to cyclophilin and inhibits calcineurin - Normally calcineurin activates nuclear factor of activated T cells cytoplasmic (NFATc) which up regulates IL-2 - Less activation of transcription factor NFATc and less IL-2 - This (less IL-2) inhibits T cell growth, differentiation and activation
117
You are treating a 63-year-old woman with small cell lung cancer who develops SIADH. She becomes disoriented secondary to hyponatremia. Consequently, you rapidly correct the low serum sodium with demeclocycline and water restriction. The patient’s sodium level and disorientation improve, but several days later the patient develops diplopia. What is the cause of this patient’s diplopia?
- Na was corrected too quickly - While pt was hyponatremic there was swelling of the brain tissue bc free water moved from an area of low osmotic pressure (serum) to an area of high osmotic pressure (neurons of brain) - Then when the sodium was correct, the free water tries to balance itself out and the fluid is sucked back out of the brain tissue and goes back into serum - This causes damage to the Pons, called Central Pontine Myelinolysis (CPM) - CPM can cause diplopia, dysarthria, paralysis or locked-in syndrome - Can happen days-weeks after hyponatremia was corrected
118
What are some of the possible causes of pericarditis?
- Idiopathic - Coxsackie virus A or B - Tuberculosis - Uremia - Lupus - Scleroderma - Radiation of the chest - Acute rheumatic fever (pancarditis, can affect all layers of the heart including the pericardium) - Dresslers syndrome (pericarditis following weeks after an MI) - Cancer mets
119
A unilateral lesion to the lateral corticospinal tract results in motor deficits ipsilateral to the lesion. Where in the lateral corticospinal tract is the motor innervation to the legs located?
Lateral part of lateral corticospinal tract | arms are most medial- Legs are Lateral
120
In cystic fibrosis thick, mucous secretions inhibit digestive enzymes, which can lead to malabsorption of fat and fat-soluble vitamins. What are the fat-soluble vitamins? What are the corresponding symptoms of fat-soluble vitamin deficiency?
A- night blindness, dry skin D- rickets (kids, bent/deformed bones) and osteomalacia (adults, and hypocalcemia in tetany) E- fragile RBCs, muscle weakness, demyelination of CNS K- coagulation factor defects (bleeding gums, epistaxis, heavy menstrual periods), osteoporosis, coronary artery disease
121
A 22-year-old man recently lost his leg in a tragic accident involving alcohol and heavy machinery. Just prior to discharge, a vigilant nurse informs you that the patient has been very depressed about his lost limb, and she overheard him talking to a friend about just ending his life with his dad’s gun when he gets out of the hospital. What needs to be done?
- Assess the seriousness of the threat - Evaluate suicide risk factors: male sex, depression, alcohol use, organized plan, access to a gun - Recommend voluntary hospitalization - If he refuses, seek involuntary hospitalization under a medical warrant
122
What branchial arch derivative abnormality causes facial abnormalities by affecting Meckel’s cartilage? What cranial nerves are affected in this abnormality? From what germ layers are the branchial arches derived?
- Meckel's cartilage comes from 1st branchial arch - CN V2 and CN V3 - Muscles and arteries, derived from mesoderm - Bones and cartilage, derived from neural crest
123
A 22-year-old man who recently immigrated from a developing country is seen at the county health clinic with a complaint of a chronic but recently worsening productive cough and sinusitis symptoms (e.g., headache). He also mentions to you privately that he and his wife have not been able to have children despite trying for two years. While you note this last complaint, you order a chest x-ray out of concern this man may have TB given his immigration status. The chest x-ray appears backwards on the display, but you realize this man’s heart is actually on the opposite side of his chest. What is the primary defect in this syndrome, and what are the characteristic symptoms/signs?
Kartagener Syndrome (primary ciliary dyskinesia) - Defect in cilia - Bronchioles won't stay open, rest infections, cough - Recurrent sinusitis, infertility (immotile sperm) - Situs inversus is commonly seen too
124
A mutation in which proto-oncogene is most commonly associated with Hirschsprung disease?
RET gene mutation -RET codes for proteins that assist cells of the neural crest, that later become ganglion cells, in their movement through the digestive tract during the development of the embryo
125
When screening a population for a particular disease, would you rather have a high sensitivity or a high specificity? What test is used to screen for HIV? What test is used to confirm a positive HIV screen?
High sensitivity to start with- this is the probability that a person will test POSITIVE Screen for HIV- ELISA (high sensitivity but high false positive rate) Confirm for HIV- Western Blot (high specificity, high false negative rate)
126
How do primary and secondary hyperaldosteronism differ in their effect on plasma renin levels? What agent is used to treat primary hyperaldosteronism?
Primary hyperaldosteronism (caused by an aldosterone secreting tumor): - decreased plasma renin (via negative fb) - Tx: spironolactone (aldosterone antagonist) ``` Secondary hyperaldolsteronism (caused by JG of kidney, perceiving a low intravascular volume): -HIGH plasma renin ```
127
Amyloidosis and sarcoidosis are associated with which cardiomyopathy? What are some other diseases or conditions associated with this cardiomyopathy?
Restrictive/obliterative cardiomyopathy - Restrict function of tissue because of amyloid deposits, etc. - Associated with restrictive cardiomyopathy: post radiation fibrosis, endocardial fibroelastosis, loffler syndrome, hemochromatosis
128
What does the eustachian (auditory) tube connect? What is its purpose? What drug is commonly prescribed for eustachian tube dysfunction?
- Connects middle ear to nasopharynx - makes the pressure in the middle ear the same as atmospheric pressure - Intranasal steroids
129
What is the most common renal malignancy in adults? What is the associated gene deletion with this malignancy?
- Renal cell carcinoma (hematuria, flank pain, palpable flank mass) - Gene deletion in chromosome 3 (also associated with von hippel lindau syndrome- genetic disorder of tumors and cysts in different parts all over body)
130
A pediatric patient presents with a noticeable right flank mass. The patient’s mother also reports blood in the patient’s urine. What malignancy would be most likely in this scenario? What is the WAGR complex?
- Wilms tumor (nephroblastoma) - 2 to 4 year old with flank pain, flank abdominal mass and hematuria - WABR complex: tetrad of Wilms' tumor, Aniridia (absence of the iris), Genitourinary malformation and Retardation (mental motor) - Caused by deletion of WT1 tumor suppressor gene
131
A 24-year-old young man is fired from his job, and when explaining the chain of events to his roommate, he says that “it doesn’t really matter. I didn’t even need that job.” His roommate is perplexed, wondering how they will pay their rent. Of which immature ego defense could this be an example?
Rationalization
132
What is the definition of tidal volume, residual volume, and vital capacity?
Tidal volume- amount of air that moves in and out of your lungs with each normal breath Residual capacity- when you blow out as much air as you can, the amount of air left in your lungs is residual capacity (can't ever completely empty your lungs) Vital capacity- Max amount of air you can take into your lungs MINUS the residual volume (AKA- take in deepest breath you can and the blow out as much air as you can, add these two and thats the vital capacity); amount of air you can blow out when you inhale as much as possible and then exhale as hard has possible
133
What is the difference between mean, median, and mode? What are their relationships in a positively- skewed curve and a negatively-skewed curve?
mean- average medial- middle value mode- most frequent value -In a perfect bell shaped curve, mean=median=mode -Positive skew: curve is shifted left, tail shifts right, mean > median > mode -Negative skew: curve is shifted right, tail shifts left, mode > median > mean
134
What foods, typically high in mercury, should be avoided during pregnancy?
Fish (especially big fish that eat other fish, accumulate mercury from smaller fish) -Avoid: Shark, Swordfish, King mackerel, Tilefish -mercury causes brain damage
135
When an infant is born and takes its first breath, the lungs expand and create negative pressure that draws blood into the pulmonary circulation. Because the pressure in the pulmonary circulation is lower than that in the aorta, blood preferentially flows into the pulmonary circulation and the ductus arteriosus closes. What other fetal blood vessels are closed in the adult circulation?
- Umbilical vein (becomes ligamentum teres hepatis, inside the falciform ligament) - Umbilical arteries (become medial umbilical ligament) - Ductus arteriosus (becomes ligamentum arteriosum) - Ductus venosus (liver shunt, becomes ligamentum venosum) - Foramen ovale (R vent to L vent shunt- skips lungs, becomes fossa ovalis)
136
You are rotating with an anesthesiologist and learning to calculate dosages of anesthetics with her. How does the rate of elimination differ between zero-order elimination and first-order elimination? Which type of elimination behaves as though the enzymes responsible for the elimination are saturated?
Zero order is not dose dependent- like alcohol; 1 drink/hour no matter how much you drink, acts as if you saturate the enzymes (Constant amount of drug eliminated per time- graph is linear) First order is dose dependent- if you take less, enzymes work quicker to metabolize it (curved graph, constant fraction of drug is metabolized per drug; 20% metabolized in 1st hour, 15% metabolized in 2nd hour, etc.)
137
What artery supplies the distal third of the colon? What artery supplies the proximal two-thirds of the colon? From what embryonic structures are the distal third and proximal two-thirds of the colon derived?
distal 1/3- inferior mesenteric artery (from embryonic hindgut) proximal 2/3- superior mesenteric artery (from embryonic midgut)
138
What is the mechanism of action and clinical use for varenicline?
- Partial agonist at nicotinic acetylcholine receptors - used for smoking cessation - black box warning for neuropsych (depression, suicide)
139
What anticonvulsants are used to treat absence seizures? What anticonvulsants are used to treat status epilepticus?
Absence seizures- Ethosuximide (#1 choice) Valproic Acid Status epilepticus- - acute to stop seizures, Benzodiazepines like Diazepam or Lorazepam - once its stopped, give anticonvulsant to prevent further seizure, Phenytoin (prophylaxis)
140
Inhaled treatment of choice for chronic asthma
corticosteroids | Fluticasone, Budesonide
141
Inhaled treatment of choice for acute exacerbations of asthma
Albuterol (or Levalbuterol)
142
Narrow therapeutic index, drug of last resort (for asthma)
Theophylline
143
Blocks conversion of arachidonic acid to leukotriene (for asthma)
Zileuton
144
Inhibits mast cell release of mediators, used for prophylaxis only (for asthma)
Cromolyn sodium
145
Inhaled treatment that blocks muscarinic receptors for asthma
Ipratropium, Tiotropium
146
Inhaled long-acting β2-agonist for asthma
Salmeterol
147
Blocks leukotriene receptors (for asthma)
Montelukast, Zafirlukast
148
Which diuretics are most appropriate for patients with hyperaldosteronism? What are their important side effects?
Spironolactone Eplerenone (aldosterone antagonists) Increase K reabsorption (hyperkalemia), block aldosterone *Spironolactone is androgen antagonist (gynecomastia in men) and progesterone agonist (menstrual irregularities in women)
149
What is the mechanism of action of neomycin? What are the toxicities with this class of medication?
- aminoglycoside - prevent protein synthesis - bind 30S subunit of bacterial ribosomes, inhibit formation of the **nephrotoxic, ototoxic and teratogenic**
150
How does flutamide differ from finasteride in relation to mechanism of action and clinical use?
- Both used for prostate pathology - Fultamide: Prostate CANCER (competative testosterone receptor inhibitor) - Finasteride: BPH (inhibits 5 alpha-reductase, converts testosterone to DHT, can also be used for male pattern baldness)
151
Which bone is commonly fractured when falling on an outstretched hand, resulting in deep pain in the anatomical snuffbox?
Scaphoid
152
What might you observe in a patient who presents to the emergency room with PCP intoxication?
- Psychomotor agitation, impulsiveness, psychosis, belligerence, homicidality, aggressive/violent - Fever, tachycardia - Vertical and horizontal nystagmus
153
IFN-gamma stimulates macrophages and inhibits Th2 cells. What cell type releases IFN-gamma?
Th1 cells | T helper 1 cells
154
How does the mechanism of action of benzodiazepines differ from the mechanism of action of barbiturates? What toxicities of barbiturates can be fatal?
-Benzos increase the FREQUENCY of GABAa (inhibitory neurotransmitter) receptor opening (GABAa receptor is a Cl channel) -Barbiturates increase the DURATION of GABAa receptor Ch channel opening **Barbiturates have CNS depressive effects, respiratory depression and bradycardia (worse with alcohol)
155
What are the symptoms of decompression sickness?
- N gas forms bubbles in blood when diver comes up too quickly - Joint and muscle pain - Neuro symptoms (dizzy, syncope, paralysis) - "The chokes" (dyspnea, pulmonary edema, death)- rare
156
A 40-year-old man is beginning to have symptoms of a resting tremor, postural instability, and mask- like (expressionless) facies. What is the antiviral drug that can be used against this disease, and what is its mechanism of action?
Parkinsonism - Amantadine (antiviral) - causes increased release of dopamine (not used much for flu anymore)
157
A 28-year-old man is being treated with the combination of bleomycin, etoposide, and cisplatin for metastatic non-seminoma testicular cancer. The patient develops shortness of breath during the course of treatment. Pulmonary function testing indicates that he has a restrictive lung disease. Which of the chemotherapy agents is responsible for this restrictive lung disease? Which agent in the above regimen works by inducing free radicals to interfere with DNA structure?
Bleomycin- restrictive lung disease (also methotrexate and busofan can cause this) Bleomycin also induces free radicals to interfere with DNA
158
A 55-year-old alcoholic is admitted to the hospital for an upper GI bleed. A ruptured esophageal varix is found to be the cause. What is the preferred medical treatment for this condition?
Octreotide (long acting, splanchnic vasoconstriction) Non medical- Endoscopically ligate with small rubber bands so they can't bleed
159
A 3-day-old preterm infant delivered at 34 weeks gestation develops neonatal respiratory distress syndrome (RDS). Which type of pneumocyte is affected in RDS? What is the mechanism that leads to poor O2-CO2 exchange at the gas exchange barrier in preterm infants with RDS? How could you increase surfactant production in preterm neonates?
- Type II pneumocytes - Don't have enough surfactant to keep alveoli open for gas exchange (decrease surface tension) ALSO: - Hyaline membranes form (fibrin, cellular debris, RBCs, neutrophil, macrophages) and impeded gas exchange - RDS may be called hyaline disease of the newborn - Increase surfactant by giving mom glucocorticoids BEFORE delivery (steroids mature type II pneumocytes to produce surfactant)
160
What structures make up the gas exchange barrier in the lungs?
Type I pneumocytes, basement membrane of pulmonary capillaries, endothelial cells of pulmonary capillaries
161
What is the antidote for digoxin toxicity?
- Normalize potassium and Mg - Give Lidocaine for any arrhythmias (Digoxin immune Fab fragments- DigiFab, hardly ever used)
162
What are some of the circumstances in which information is HIPAA-exempt, meaning that your health information can be shared with another party?
- Child abuse - Birth or death - State mandated reportable illnesses - Public health disease surveillance - State sponsored disease intervention activities - Schools (can ask about vaccination status)
163
Hydatidiform mole is the most common precursor of what ovarian germ tumor? What tumor marker is monitored after the dilation and curettage of a hydatidiform mole?
- Choriocarcinoma | - beta-hCG is monitored for 6 months
164
You are reading a research article about the prostate specific antigen test, and it mentions that the PSA blood test is associated with a high false positive frequency. In your own words, explain what false positive means.
Test is positive even thought disease is NOT present
165
Bleeding time for Platelet disorder vs. coagulation factor defect
REMEMBER: platelets act first to form a platelet plug, then coagulation cascade starts after this and forms a fibrin clot that lasts much longer - Platelet disorder: prolonged bleeding time - Coag factor defect: normal bleeding time
166
PT & PTT for Platelet disorder vs. coagulation factor defect
- Platelet disorder: normal PT and PTT | - Coagulation factor defect: prolonged PT and PTT (bc these are determined by coag cascade/factors)
167
Clinical features for Platelet disorder vs. coagulation factor defect
- Platelet disorder: small hemorrhages, like epistaxis, petechiae purpura - Coagulation factor defect: hemarthrosis, intracranial hemorrhages
168
How does MRI differ from CT imaging?
MRI- no ionizing radiation; better for looking at soft tissues (brain, spinal cord, ligaments and cartilage, like ACL tears); caution with metal objects (pacemakers); bones show up gray CT- uses ionizing radiation (try not to do on pregnant women); used to see bone detail and recognition of blood (especially in brain); no problem with metal; bones show up white (just like in X-ray)
169
A 45-year-old woman presents to the ER with complaints of chest pain, a racing heart beat, and dizziness. Examination reveals a heart rate of 120 /minute, blood pressure of 116/74 mm Hg, and 20 respirations/minute. The patient is diaphoretic and anxious. An initial EKG reveals ventricular tachycardia with shifting sinusoidal waveforms. What is this classic EKG finding? What are the possible causes of this patient’s condition?
EKG- torsades de pointes Causes- anything that prolonged QT interval (drugs like antiarrhythmics and antibiotics, hypokalemia or hypomagnesemia) - CHECK ELECTROLYTES - Give IV Mg and maybe K - Congenital long QT syndromes can cause this too
170
A patient of yours with recent complaints of weakness, pallor, craving for ice chips and tachycardia has a history of chronic hemorrhoids. What do you immediately suspect is the cause of this patient’s anemia and how do you treat it?
Pica- craving of nonfood (ice chips) is CLASSIC for iron deficiency anemia -Treatment is iron replacement and maybe colonoscopy if pt is older (check for colon cancer)
171
What enzymes do obligate anaerobes lack?
catalase (breaks down hydrogen peroxide to form water and oxygen) and/or superoxide dismutase (converts oxygen radicals to water and hydrogen peroxide)
172
What embryological structural abnormalities might account for multiple miscarriages? What structures arise from the paramesonephric ducts? What other name is given to the paramesonephric ducts?
- Abnormalities: Incomplete fusion of paramesonephric ducts (bicornuate uterus) - Fallopian tubes, uterus and upper vagina arise from this - mullarian ducts is other name
173
An elderly patient fell and struck his head on a coffee table. His family brought him to the ER. He is currently conscious and at his neurological baseline. Non-contrast CT of the head reveals a crescent shaped radiopacity that follows the contour of the skull crossing suture lines. What type of intracranial hemorrhage might this be and which vessel(s) would be involved?
- subdural hemorrhage | - bridging veins
174
Where is most of the cerebrospinal fluid (CSF) generated? What is the function of CSF?
- most CSF is made in the 2 choroid plexuses of lateral ventricles of the brain - functions: suspend the brain, bathes the neurons in homeostatic medium for regulation of pH and electrolytes, creates a route for chemical messengers to be distributed into the nervous system
175
A child presents with nephritis, deafness and ocular dysfunction. What is the diagnosis? A gene defect in what type of collagen contributes to the dysfunctions associated with this syndrome? What type of collagen organizes bone, skin and tendons? What type of collagen organizes cartilage?
Alport Syndrome "Can't see, can't pee, can't hear high C" *defect in type IV collage, makes up basal membrane - type 1 collagen- bone, skin, tendons - type 2 collagen- cartilage
176
What is the composition of a nucleosome? Which histone ties nucleosomes together?
- Nucleosome is the basic packaging of DNA, its wound twice around a core of histone proteins - Histone proteins: H2a, H2b, H3 and H4 (2 of each, 8 total) - create a nucleosome core that DNA can wrap around - binds negatively charged DNA but having LOTS of positively charged amino acids (tons of Lysine and Arginine) -Histone H1 ties nucleosomes together
177
At what positive G force does visual “black-out” occur? Why does this occur?
- happens with an astronaut or pilot blacks out - Occurs at 4-6G - G forces pools blood in abdomen and legs, insufficient blood flow to heart and low perfusion of brain= black out
178
The dorsal root ganglion is considered gray matter within the spinal cord. From what embryological derivative are the dorsal root ganglia derived?
- from neural crest (from ectoderm) | - KNOW LAYERS
179
A 40-year-old woman treated with lisinopril for stage I hypertension becomes pregnant. Why are ACE inhibitors contraindicated in pregnancy? What centrally acting α2-agonist is often used to treat hypertension in pregnancy?
- Teratogenic (ACE inhibitors and also ARBs like Losartan) - 1st trimester: cardiac and CNS malformations - 2nd and 3rd trimesters: renal problems - Use Methyldopa
180
Which complement protein is an opsonin? Which complement protein aids in neutrophil chemotaxis? Which complement proteins form the membrane attack complex?
- IgG and C3b are main ones - C5a (chemotaxis) - MAC is made from C5b, C6, C7, C8, C9
181
A 42-year-old obese man presents with a complaint of severe pain in his right knee. He believes he injured it while dancing at his cousin’s wedding last night. You suspect gout. How would you differentiate between gout and pseudogout upon exam of synovial fluid aspirate?
Gout- monosodium urate crystals, needle shaped, look YELLOW under parallel light (negatively birefringent) Psuedogout- calcium pyrophosphate crystals, rhomboid shaped, BLUE under parallel light (positively birefringent)
182
A child is noticed to be yellow by a visiting relative, so he was brought to the clinic. His exam revealed jaundice and splenomegaly. The patient’s lab results reveal anemia and spherocytes. What test is used to confirm the diagnosis of hereditary spherocytosis? What findings are associated with hereditary spherocytosis?
- A defect in RBC cytoskeleton proteins (Spectrin, Band 3, Pallidin, Ankyrin) - RBC isn't disc shaped, its spherical - Testing: Osmotic fragility test (put RBCs in increasingly osmotic solutions and see if they lyse quicker than usual) - Flow cytometry is newer - Other findings: RBCs are round, microcytic, no central pallor, increased MCH and RDW, extravascular hemolysis (spleen recognizes them as abnormal and removes them), Coombs Negative (only tests for Ab mediated hemolysis and this is NOT), splenomegaly, gallstones, plastic crises with stress like viral infection (parvo B19)
183
What enzyme catalyzes the rate-limiting step in cholesterol synthesis? What class of drugs inhibits this enzyme?
- Rate limiting enzyme is HMG coA reductase | - Drug that inhibits it are Statins (Simvastatin and Atorvastatin)
184
What arteries supply the adrenal glands? From what arteries do these arteries arise?
- Superior adrenal artery (from inferior phrenic artery) - Middle adrenal artery (from aorta directly) - Inferior adrenal artery (from renal artery)
185
Many factors are involved in the proper morphogenesis of organs in utero. In the case of oligohydramnios, lack of fluid flowing in and out of the fetal lungs leads to pulmonary hypoplasia. This is an example of which type of error in organ morphogenesis?
-Hypoplasia (incomplete organ development)
186
Complement deficiency if you have frequent Neisseria infections?
C5, C6, C7, C8, C9
187
Complement deficiency if you have frequent pyogenic respiratory tract infections
C3 (especially with h. influenza and strep pneumonia)
188
Complement deficiency if you have frequent nocturnal hemoglobinuria
CD55, CD59 (prevents compliment from attacking RBCs, complex is also called decay activating factor, DAF)
189
Complement deficiency if you have increased frequency of type III hypersensitivity reaction
C3 (causes glomerulonephritis specifically)
190
Which neoplasm is most commonly responsible for ACTH that leads to Cushing's syndrome?
Small cell lung cancer
191
Which neoplasm is most commonly responsible for PTH-related peptide that leads to hypercalcemia?
squamous cell lung cancer
192
Which neoplasm is most commonly responsible for Erythropoietin that leads to polycythemia
- Renal cell carcinoma - Hemangioblastoma - Hepatocellular carcinoma - Pheochromocytoma
193
Which neoplasm is most commonly responsible for ADH that leads to SIADH
- Small cell lung cancer | - Intracranial neoplasms
194
What nerve is damaged when a patient presents with claw hand?
ulnar
195
What nerve is damaged when a patient presents with ape hand?
median
196
What nerve is damaged when a patient presents with wrist drop?
radial
197
What nerve is damaged when a patient presents with scapular winging?
long thoracic
198
What nerve is damaged when a patient is unable to wipe bottom/anus?
thoracodorsal
199
What nerve is damaged when a patient presents with loss of forearm pronation?
median
200
What nerve is damaged when a patient is unable to abduct or adduct fingers?
ulnar
201
What nerve is damaged when a patient presents with loss of arm abduction?
axillary
202
What nerve is damaged when a patient presents with weak lateral rotation of arm?
suprascapular and/or axillary
203
What nerve is damaged when a patient presents with loss of arm and forearm flexion?
musculocutaneous
204
What nerve is damaged when a patient presents with loss of forearm extension?
radial
205
What nerve is damaged when a patient presents with trouble initiation arm abduction?
suprascapular
206
What nerve is damaged when a patient is unable to abduct arm beyond 10 degrees?
axillary
207
What nerve is damaged when a patient is unable to raise arm above horizontal?
long thoracic
208
What renal pathology is characteristic of RBC casts and proteinuria?
glomerulonephritis | but can also see this with acute malignant hypertension with end-organ damage of the kidneys or acute renal ischemia
209
In which pulmonary disease would you see an increased Reid index?
- Reid Index: Gland depth divided by the total thickness of the bronchial wall - In COPD and chronic bronchitis, it will be greater than 50%
210
A 56-year-old man develops right lower extremity edema after returning from Europe from a business trip. An exam of the right lower extremity demonstrates a red, warm, lower leg with a positive Homan’s sign. What is the patient’s diagnosis? What is a positive Homan's sign? What is Virchow’s triad? What is the most common inherited hypercoagulability syndrome?
- DVT - Positive Homan's sign is pain in calf with passive dorsiflexion of patients foot - Virchow's Triad: Stasis, hyper coagulability and endothelial damage - Most common inherited hypercoagulability syndrome is Factor V Leiden mutation (factor 5 can't be degraded by protein C, can't control clotting cascade)
211
Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in patients with benign prostatic hyperplasia (BPH)? What is the difference between the prostate exam findings in BPH versus adenocarcinoma of the prostate?
Alpha 1 antagonists (terazosin, prazosin, doxazosin) - BPH findings shows prostate to be symmetric, smooth and enlarged - Adenocarcinoma shows prostate to be asymmetric and you will feel a hard nodule
212
A type 2 diabetic with a HgbA1c of 10% presents to your clinic with many complaints. You are concerned about the effect of the patient’s long-term hyperglycemia. What diabetic complications can be attributed to sorbitol-induced osmotic damage? Which enzyme converts glucose to sorbitol?
- Sorbitol induced osmotic damage; in the cells, glucose os converted to the sugar-alcohol sorbitol, normally sorbitol is then converted to fructose, but some tissues don't have enzymes to convert sorbitol (like in the eye and schwann cells). Sorbitol then gets trapped in the cells and acts as an osmole (draws fluid into cells, causes swelling and damage) - Damage to Schwann cells causes demyelination and diabetic neuropathy - Damage to lens causes cataracts - Enzyme that converts glucose to Sorbitol is Aldose reductase - Sorbitol is converte to fructose by *sorbitol dehydrogenase* (this is missing in schwann cells) -Can also have glycosolation of blood vessels where free glucose gets tacked onto blood vessels in kidneys, retina and coronary arteries (damaging)
213
Which efferent fibers carry input from the brain that influences the outer hair cells (OHCs) of the cochlea in much the same way that gamma motor neurons influence muscle spindles? What is the result of this input? What is the result of damaging the OHCs (as with antibiotics such as gentamicin and streptomycin)?
- Olivocochlear bundles (go from superior olive to cochlea) - Result of this input is contraction of outer hair cells and stiffening of basilar membrane in cochlea which sensitizes the inner hair cells to a particular frequency - This always you to pick out specific sounds from background noise - Damaging hair cells causes wide deflection of basilar membrane (instead of the normal sharp deflection) causing hearing loss
214
What is type II (β) error?
study results show no difference between 2 groups, which a difference really does exist between the two
215
A child in India is brought to the doctor with symptoms of muscle weakness, malaise, headache, fever, and hyporeflexia. For the past few weeks, he had been swimming in a waterway known to contain sewage. You think this boy has contracted a pathogen via the fecal-oral route. Which area of the body is this pathogen attacking to give the neurologic symptoms seen?
- polio virus - gets into CNS and destroys cells of anterior horn on spinal cord - causes lower motor neuron destruction
216
What are the risk factors for osteosarcoma?
bone infarcts, radiation, paget disease of the bone, familial retinoblastoma, male sex, ages 10 to 2- years
217
What disorders can cause cotton-wool spots on the retina?
chronic HTN and diabetes (diabetic retinopathy), AIDS, lupus, temporal arteritis (giant cell arteritis), Wegners granulomatosis, polyarteritis nodosum
218
Which cardiac valve is most commonly involved in infective endocarditis and acute rheumatic fever?
Mitral valve | Tricuspid valve most affected w/ IV drug use
219
Which syndrome associated with elevated cortisol and central obesity is a common causes of anovulation?
Cushings syndrome
220
Which syndrome associated with amenorrhea + hirsutism + obesity is a common cause of anovulation?
PCOS
221
Which neurotransmitters in the brain are increased or decreased with schizophrenia?
dopamine is increased
222
Which neurotransmitters in the brain are increased or decreased with Parkinsons disease?
- Dopamine is decreased (in substantia nigra) | - Ach and serotonin are increased
223
Which neurotransmitters in the brain are increased or decreased with Alzheimers disease?
Ach is decreased
224
Which neurotransmitters in the brain are increased or decreased with Huntington disease?
- Ach and GABA are decreased | - Dopamine is increased
225
Which neurotransmitters in the brain are increased or decreased with anxiety?
- Increased NE | - serotonin and GABA are decreased (SSRIs used)
226
Which neurotransmitters in the brain are increased or decreased with depression?
NE, serotonin and dopamine are decreased | SSRIs used
227
What is the underlying cause of DiGeorge syndrome? What are the manifestations of DiGeorge syndrome?
- failure of 3rd and 4th branchial pouch to form - Gene deletion on chromosome 22 - Manifestations: athymic, aplasia of parathyroids, cleft plate, tetany (hypocalcemia), recurrent viral and fungal infections (no T cell development), abnormal facial features, congenital defects of heart and great vessels
228
Ceftriaxone is used for the treatment of sexually-transmitted N. gonorrhea infections. Which generation of cephalosporin is ceftriaxone? Which generation of cephalosporin is effective against Pseudomonas? Are cephalosporins bacteriostatic or bactericidal?
- Cephtriaxone= 3rd generation cephalosporin - Pseudomonas is treated with 4th generation cephalospirings (like Cefepime), but also a select few of the 3red generations (Ceftazidime and Cefoperazone only) -Bacteriocidal (beta lactam antibiotics like cephalosporins and penicillins are cidal because they interfere with cell wall synthesis so bacterial can't live)
229
A 35-year-old white woman presents with a dull ache in her jaw that is made worse by chewing. She states that this pain corresponds to her recent promotion and increase in responsibilities. What is the most likely diagnosis?
- TMJ - Young women in 20s-30s - exacerbated by stressful life events - have nocturnal bruxism - 2nd most common cause of facial pain - may feel clicking of jaw
230
A patient is undergoing treatment with recombinant interferon for his hepatitis C. In what ways do interferons interfere with viral protein synthesis?
- Induces an RNA protein kinase (degrades viral mRNA to inhibit viral protein synthesis) - Trigger pro-apoptitic pathways - Influence the activities of macrophages and dendritic cells
231
Your patient develops a cough with the new antihypertensive drug you prescribed her. What are some other side effects associated with this medication?
- ACE inhibitors cause dry cough (MUST KNOW) - My switch to ARB if cough is bad - ACE inhibitors also cause angioedema (lips or throat which may cause airway obstruction) - Renal insufficiency - Hyperkalemia - Teratogenic
232
In regard to seizures, what do the terms partial, generalized, simple and complex mean?
- Partial means only 1 area of the brain is affected (usually temporal lobe) - Generalized means there is diffuse involvement of the brain - Simple means consciousness is in tact (aware they are having a seizure) - Complex means you lose consciousness for more than 2 minutes
233
How is thyroid hormone made and stored?
1. Epithelial cells lining the thyroid follicle bring in iodide from blood with Na-Iodide cotransporter (using Na gradient to move I against its concentration gradient) 2. Once in the follicle, Iodide (I-) is oxidized by peroxidase and is turned into Iodine 3. Iodine (I2) is bound to thyrogolbulin (tyrosine residues)--> this process is called "organification" of iodine 4. MIT (monoiodityrosine) and DIT are made (diiodotyrosine), they are all linked together to make T3 and T4 (has 4 iodines) **T3 is active thyroid hormone, but most of what gets released is T4, and its later converted to T3 in periphery -Most of T3 and T4 stays attached to thyroglobulin molecule and stays in colloid -Follicles in thyroid can store a bout 2-3 months of thyroid hormone in colloid -TSH causes released of T3 and T4
234
A 35-year-old man is seen in the office for his chronic, recurrent peptic ulcer disease. It has been refractory to conventional treatment with PPIs. Your attending mentions that this might be caused by a tumor. Which type of tumor may be responsible for this condition? If this patient also presented with kidney stones and signs of hypogonadism, what syndrome might you suspect?
- Zollinger Ellison syndrome (gastrin secreting tumor) - Gastrin stimulates gastric acid secretion - If pt has ZE syndrome, plus kidney stones --> think calcium build up, most common cause of hypercalcemia is hyperparathyroidism, but this doesn't help with other s/s - If you see hypogonadism, think pituitary disease, prolactinoma (prolactin secreting pituitary tumor) * *THINK MEN 1 (multiple endocrine neoplasia type 1)**
235
What is the role of clomiphene in the treatment of PCOS? What is the mechanism of action of clomiphene?
* PCOS: polycystic ovaries, androgen excess, involution or oligovulation - Clomiphene induces ovulation, its an estrogen antagonists (blocks fb inhibition in hypothalamus) - Increases release of FSH and LH so patient can ovulate
236
A 49-year-old trauma patient comes into the ER unconscious and in need of surgery. What are the exceptions to informed consent?
- Emergency situations - Patient lacks decision making capacity - Therapeutic Privilege (withhold medical info if you think it will alter persons decision making process- very rarely used) - Waiver (patient gives up right for consent and allows doctor or family to have consent)
237
What are the side effects of amiodarone, and what testing should be performed periodically on patients taking it?
*Amiodarone is used to treat heart rhythm problems (class III antiarrhythmic) -Pulmonary function tests (can cause pulmonary fibrosis) -Liver function tests (can cause hepatotoxicity) -Thyroid function tests (PFT, LFT, TFT) -OTHER side effects: corneal deposits, neuro problems (tremor, ataxia, neuropathy), constipation, photosensitivity and blue-gray skin discoloration (iodine accumulation in skin- also why it affects thyroid function)
238
When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus?
- Embryonic period (weeks 3-8) - ACE inhibitors (Captopril, Lisinopril, Enalapril) - ARBs also (Losartan, Valsartan, Candesartan) - Cause fetal kidney damage
239
How is the body affected by a prolonged stay in space at zero gravity?
- Decrease in blood volume - Decrease in RBC mass - Decrease in muscle strength and work capacity - Decrease in maximum cardiac output - Loss of calcium and phosphate from the bones (loss of bone mass)
240
What is the most common gynecologic neoplasm? What is the typical histological pattern? Is it benign or malignant?
- Leiomyoma (fibroid) - "whorled pattern", smooth muscle bundles oriented in different directions - Benign
241
How does Acetazolamide affect nephron function?
Sodium bicarb diuresis | it's a carbonic anhydrase inhibitor
242
How does Mannitol affect nephron function?
Increases urine flow | it increases tubular fluid osmolarity
243
How does Furosemide affect nephron function?
Prevents concentration of the urine | it inhibits the Na-K-Cl cotransporter
244
How does Hydrochlorothiazide (thiazides) affect nephron function?
Reduce the diluting capacity of the nephron | inhibit Na and Cl reabsorption
245
How does Potassium sparing diuretics affect nephron function?
Competitive aldosterone receptor antagonist (how Spironolactone works)
246
How do ADH antagonists affect nephron function?
Blocks the action of ADH receptors (causing diuresis- aka excessive urine production)
247
How are the following relative component levels in the blood of a polycythemia vera patient different from normal: plasma volume, RBC mass, O2 saturation, and endogenous erythropoietin?
- Myeloproliferative disorder where the bone marrow is making too many RBCs (other cells too, and blood gets very thick) - It's a neoplasms of red cell precursors (isn't actually cancerous itself) - Increased plasma volume - Increased red cell mass - Normal O2 saturation - Decreased erythropoietin (don't need to stimulate bone marrow even more)
248
What synthetic agent is used both as a pituitary hormone analog and as a treatment for von Willebrand disease?
Desmopressin (DDAVP) which is a synthetic analog of ADH
249
What agent can be given as an inhaled drug to loosen mucus plugs, can be given orally to treat acetaminophen overdose, and can be given orally as prophylaxis against IV contrast-induced nephropathy in those with preexisting renal disease?
N-acetylcystine
250
Which type of diabetes mellitus is associated with obesity?
Type II
251
Which type of diabetes mellitus may cause ketoacidosis?
Type I | rare in Type II
252
Which type of diabetes mellitus has a strong genetic predisposition?
Type II
253
Which type of diabetes mellitus is associated with HLA-DR3 and DR4
Type I
254
What viral illness is associated with Burkitt lymphoma? Is Burkitt lymphoma a neoplasm of mature T or B cells? Where are T cells found in the spleen? Where are B cells found in the spleen?
- EBV is associated with Burkitt lymphoma - B cell lymphoma - In the spleen, T cells are found in the white pulp and periarterial lymphatic sheath) - B cells are found in the white pulp
255
In which lobe of the brain would you find Broca's area (motor speech)
frontal lobe | inferior frontal gyrus
256
In which lobe of the brain would you find Wernicke's area (speech understanding)
temporal lobe
257
In which lobe of the brain would you find the primary auditory cortex?
temporal lobe
258
In which lobe of the brain would you find the principal visual cortex?
occipital lobe
259
In which lobe of the brain would you find the primary sensory cortex?
parietal lobe (most anterior part, just posterior central sulcus)
260
In which lobe of the brain would you find the primary motor cortex?
frontal lobe (most posterior part, just anterior to the central sulcus)
261
In which lobe of the brain would you find the premotor cortex?
frontal lobe (anterior to motor cortex)
262
What potentially fatal autoimmune skin disorder is caused by IgG antibodies against desmosomes? What is the difference between a desmosome and a hemidesmosome?
- Pemphigus vulgaris (thin blisters) - Desmosome connects cells side to side - Hemidesmosome connects an epithelial cell to the basement membrane (antibodies against hemidesomsomes cause bullous pemphigoid)
263
What is the classic presentation of granuloma annulare?
- asymptomatic - Non scaly, slightly erythematous annular plaque (ring shaped) - Irregular, well-defined edges - Thick, rope-like border - Starts small and grows outward (centrifugally) - Usually localized to the wrists, ankles and dorsal hands/feet - Palms and soles usually spared
264
A 66-year-old man is involved in a motorcycle accident and suffers a head injury that leaves him in a coma. Prior to this injury, the man met with his lawyer to write out specific instructions in case an event like this happened. What are these instructions called?
Living will (aka written advance directive)
265
An 18-year-old man is brought to your office for delayed onset of puberty. Physical exam confirms a small penis and testicles for his age, as well as lack of facial, pubic, and underarm hair. The patient also reveals that he has never been able to smell. What is the likely diagnosis?
- Kallmann syndrome - Anosmia - Hypogonadism (due to decreased synthesis of GnRH in the hypothalamus, no FSH or LH released from anterior pituitary, so you get a lack of secondary sexual characteristics)
266
A 45-year-old woman who has been taking prednisone for control of rheumatoid arthritis symptoms has recently been diagnosed with Cushing syndrome. Other than exogenous steroids, what else can cause Cushing syndrome? How does the level of ACTH help differentiate the etiology?
- Other than exogenous steroids, you could have: 1. Primary adrenal excess (adrenal gland pathology, functional adrenal adenoma or nodular adrenal hyperplasia) 2. Secondary adrenal excess (adrenals themselves aren't the problem, problem is too much ACTH; So....ACTH-secreting pituitary adenoma, aka: Cushing Disease, or Ectopic ACTH production from a non-pituitary tumor like Small Cell Lung Cancer) - If it's an ACTH producing tumor, ACTH will be high - If it's a cortisol producing tumor, ACTH will be low (cortisone will suppress ACTH thru negative fb)
267
Describe the flow of blood into and out of the thyroid gland.
External carotid artery --> superior thyroid artery Thyrocervical trunk --> inferior thyroid artery Superior, middle, and inferior thyroid veins drain the thyroid gland
268
A 30-year-old man is undergoing the Schilling test to investigate his B12 deficiency. What must be present in the enteric system in order for vitamin B12 to be absorbed?
- Intrinsic factor from parietal cells in the stomach | - B12-intrinsic factor complex is absorbed in the terminal ileum
269
The part of the brain responsible for attention and alertness has been implicated in schizophrenia, PTSD, Parkinson disease, narcolepsy, progressive supranuclear palsy, depression, and ADHD. Which part of the brain is this? (Hint: Lesion results in coma.)
Reticular activating system (part of the midbrain) - Keeps you awake and alert - Lesion here= coma
270
What is the definition of first-degree AV block? What are the symptoms of first-degree AV block?
- First degree AV block= prolongation of PR interval for > 200 msec (5 little boxes or 1 big box) - No bradycardia, completely asymptomatic, only found on EKG - Easily overlooked unless you measure PR interval!!!!
271
What are the main differences between delirium and dementia? Which is more commonly reversible?
* MUST know how to differentiate between delirium and dementia - Delirium is more commonly reversible - Delirium: waxing/waning level of consciousness, acute onset, usually secondary to acute illness - Dementia: slow decline in cognitive function, no alterations in level of consciousness, they are alert but have a loss of cognitive function (Alzheimer's or vascular disease, etc), not associated with an acute illness, usually not reversible
272
Clopidogrel (Plavix) and ticlopidine are commonly used after an MI or cardiac catheterization with stent placement. What is the mechanism of action of these drugs?
Both prevent platelet activation by irreversibly blocking ADP receptors on platelets
273
What are some of the signs and symptoms of pericarditis?
- Chest pain (sharp pleuritic pain thats worse with inspiration and relieved by sitting up and leaning forward) - Decreased capacity of R ventricle, fluid backs up and you may see JVD - With constrictive pericarditis, you may see Kussmaul sign (JVD with inspiration) - Pericardial friction rub (leathery, scratchy sound) - EKG findings show diffuse ST elevation, diffuse PR depression
274
What common over-the-counter medication is used to remove excess thick sputum by stimulating the vagus nerve to generate low viscosity secretions in the bronchial tree?
Guaifenesin (mucolytic, makes mucus thinner and easier to cough up)
275
Preventive vaccines have been developed for which encapsulated bacteria? What test can be used to detect encapsulated bacteria?
- Neisseria meningitidis - Streptococcus pneumoniae - Haemophilus influenza B - Test to detect encapsulated bacteria: add serum that contains anti capsular antibodies, look for Quellung reaction (capsule appears to swell in response to antibodies)
276
A 30-year-old Asian woman presents to the clinic with a variety of complaints. Upon completion of your exam, you suspect Takayasu arteritis. What symptoms does this patient likely have?
- Affects aorta and branches that come off aortic arch (so it affects the arms and the carotids) - S/S: lightheadedness, headaches and vision problems, arm claudication, diminished pulses in arms (pulseless disease) - Will see elevated ESR - Treatment is corticosteroids
277
What are the carpal bones of the wrist?
- Some Lovers Try Positions That They Can't Handle | - Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
278
A 6-year-old boy is receiving poor grades in school. His teachers and parents report that he has normal intelligence but is very distractible and full of excess energy. What medications might help this boy?
- ADHD (symptoms must be present before age 12) - Treatment is stimulants like Amphetamines and Methylphenidate - Atomoxetine (not a stimulant) - Behavioral interventions
279
Why is diphenhydramine (Benadryl) a poor medication choice in the elderly and in those with BPH?
- Also has anticholinergic side effects - Delirium, confusion and urinary retention (bad for BPH) - Not good for treating chronic sleep insomnia, disrupts normal sleep architecture (poor quality of sleep, not restful)
280
On which cells would you find CD4 molecules? On which cells would you find CD8 molecules? What actions do the CD8+ cells accomplish?
- T helper cells (CD4) - Cytotoxic T cells (CD8), actions are to bind to target cells and kill them by inducing apoptosis - Kill viral infected cells, neoplastic cells and cells from a transplant donor
281
Most common breast tumor in women under 25?
Fibroadenoma
282
Most common breast mass in postmenopausal women?
Invasive ductal carcinoma
283
Most common breast mass in premenopausal women?
Fibrocystic changes of the breast
284
Most common form of breast cancer?
Invasive ductal carcinoma
285
What are the positive symptoms of schizophrenia (adding a symptom)? What are the negative symptoms of schizophrenia (removing a normal finding/trait)?
Positive- Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior Negative- flat affect, lack of motivation, lack of speech or thought
286
What is HIPAA?
Health Insurance Portability and Accountability Act | -Helps insure medical info is only seen/used by people organizing a plan for patient's care and no one else
287
Describe the anatomy of the femoral sheath. When placing a femoral line for central venous access, you palpate a femoral pulse. Where do you place the guide needle in relation to this pulse: medially or laterally?
* NAVeL--> from lateral to medial --> nerve, artery, vein, empty space, lymphatics - Tube of fascia deep to inguinal ligament - Within the sheath is the femoral artery and slightly medial is the femoral vein - NOT THE NERVE! Femoral nerve is superior to the sheath, outside the sheath - Palpate the femoral pulse (so you know where the femoral artery is) and place the needle MEDIAL to it
288
Which area of the brain is damaged in Klüver-Bucy syndrome? What are the symptoms of Klüver-Bucy syndrome?
- Amygdala (bilateral damage) - HSV 1 infection causes this - S/S: hypersexuality, disinhibited behavior, hyperorality
289
What long-term complication is associated with having to receive multiple blood transfusions?
- Iron overload (hemosiderosis or hemochromatosis) | - Sickle cell disease, they are anemic, but don't actually have low RBC count, so they may have too much iron
290
What are Cheyne-Stokes respirations?
- Repeating cycles of apnea and hypercapnia - Followed by a compensatory phase of hyperventilation and hypocapnia - Due to diminished sensitivity of medullary respiration center caused by drug overdose, cerebral atherosclerosis, cerebral lesions or prolonged circulation time from heart failure
291
Which type of immunodeficiency disorder is caused by DiGeorge syndrome? Development of which branchial pouches is affected in DiGeorge syndrome?
- T cell deficiency - 3rd and 4th branchial pouches are affected - 3rd pharyngeal pouch gives rise to inferior parathyroids and thymus - 4th pharyngeal pouch gives rise to superior parathyroids, since there are no parathyroids, PTH will be low, resulting in hypocalcemia
292
What drugs and endogenous hormones regulate the secretion of gastric acid?
- Gastric acid is produced by parietal cells of stomach - Histamine, Ach, Gastrin stimulate gastrin release - Prostaglandins, somatostatin, secretin, and GIP (gastric inhibitory peptide) all inhibit gastric acid secretion - PPIs, H2 blockers, and Octreotide suppress gastrin release
293
The E4 variant of Apo E is a known risk factor for Alzheimer’s disease. What is the primary function of Apo A-I?
Activates LCAT (lesothin cholesterol aceyltransferase)
294
The E4 variant of Apo E is a known risk factor for Alzheimer’s disease. What is the primary function of Apo B-48?
Mediates chylomicron secretion from enterocytes
295
The E4 variant of Apo E is a known risk factor for Alzheimer’s disease. What is the primary function of Apo B-100?
Binds LDL receptors
296
The E4 variant of Apo E is a known risk factor for Alzheimer’s disease. What is the primary function of Apo C-II?
Removes FFA from lipid particles
297
The E4 variant of Apo E is a known risk factor for Alzheimer’s disease. What is the primary function of Apo E?
(App E is on all lipoprotein particles) - Mediates extra (remnant) uptake - linked to Alzheimer's disease
298
Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each?
1. Neostigmine (reverses neuromuscular blockade, ileus, bladder atony, aka loss of strength) 2. Physostigmine (atropine overdose) 3. Edrophonium (aka Tensilon- used to diagnose myasthenia graves, only used for diagnosis, not treatment because it has a very short half life and only works for about 5 mins) 4. Pyridostigmine (treat myasthenia gravis) 5. Echothiophate (eye drops to treat open-angle glaucoma) 6. Donepezil, Rivastigmine, Galantamine (all used to treat Alzheimer's disease)
299
Clavulanic acid, sulbactam, and tazobactam aid penicillins in their activity against bacteria through what mechanism?
- b lactam ring is active part of penicillin, but bacteria can make beta lactamase and break the ring so penicillin can't work (beta lactamase enzyme may also be called penicillinase) - All 3 of these aid penicillin by inhibiting the beta lactamase - they reduce bacterial resistance to penicillin
300
Which bacteria are most commonly responsible for sialadenitis? What condition most commonly predisposes a patient to sialadenitis (inflammation of a salivary gland)?
- Staph aureus and viridans streptococci | - condition that predisposes is stone obstruction of the salivary gland duct (sialolithiasis)
301
Membranous glomerular diseases involve thickening of which structure?
basement membrane
302
An 88-year-old man arrives at the ER after he fell and struck his head. He has a history of atrial fibrillation for which he takes warfarin. Noncontrast CT of the head reveals subarachnoid hemorrhage. What is the antidote for warfarin anticoagulation or warfarin overdose? For heparin overdose?
- Give anticoagulation to afib patients to reduce their risk of stroke - Can give vitamin K to reverse Warfarin (takes days) - Can give FFP to see results of warfarin reversal immediately - Heparin OD: give Protamine Sulfate as antidote
303
What important secretory products are secreted from G cells of the GI tract?
Gastrin (antrum of stomach)
304
What important secretory products are secreted from I cells of the GI tract?
CCK (cholecystokinin, duodenum and jejunum)
305
What important secretory products are secreted from S cells of the GI tract?
Secretin (found in duodenum)
306
What important secretory products are secreted from D cells of the GI tract?
Somatostatin (found in pancreatic islets and GI mucosa)
307
What important secretory products are secreted from Parietal cells of the GI tract?
Gastric Acid and Intrinsic factor (stomach)
308
What important secretory products are secreted from Chief cells of the GI tract?
Pepsinogen
309
You recommend that your patient, a 51-year-old woman, begin taking a calcium and vitamin D supplement in order to prevent osteoporosis. What are the steps in the conversion of vitamin D to its active form in the body? By what mechanism does vitamin D help prevent osteoporosis?
1. Vitamin D from diet or sun is first converted to 25-OH vitamin D (Calcidiol) in liver 2. Calcidiol is the converted to 1,25-(OH)2 vitamin D (Calcitriol) in kidneys *Active form* -Vitamin D stimulates Ca and phosphate absorption from the gut, Ca is the input in bones, this prevents osteoporosis
310
A child arrives at the ER in hypotensive shock after taking his dad’s phenoxybenzamine. The intern on call orders the nurse to get her a pressor STAT. The nurse informs the intern that there are two pressors available in the ER, epinephrine and phenylephrine. Which one will be able to increase the blood pressure of this pediatric patient?
-Phenoxybenzamine is an irreversible alpha blocker (decrease BP, decrease peripheral vasoconstriction, reason it may cause hypotension) -Epinephrine is an alpha and beta agonist -Phenylephrine is an alpha agonist -If you give Epinephrine, it will stimulate alpha receptors AND beta 1 and 2 receptors, beta 1 will stimulate the heart and raise BP some, but stimulation of beta 2 receptors on vascular sooth muscle will cause peripheral vasodilation, and this will lower BP even more -Phenylephrine is a PURE alpha agonist (will cause peripheral vasoconstriction of vessels, increasing BP) and will NOT induce any beta 2 mediated vasodilation
311
What can occur if a MAO inhibitor (MAOI) is added to an SSRI? What is the treatment for this condition?
- SSRI inhibit re-uptake of serotonin - MAOI inhibit the enzyme that break down serotonin - both help increase serotonin - Combining these drugs makes serotonin too high, resulting in Serotonin Syndrome: tremor, hyperreflexia, muscle rigidity/clonus - This raises body temp and cause cause hyperthermia, diaphoresis, flushed skin, agitation, seizures and cardiovascular collapse - Stop serotonergic drugs, give a benzodiazepine like Lorazepam and supportive care - If none of this is working, give Cyproheptadine (an antihistamine that also blocks serotonin receptors, 5HT-1a and 2a)
312
What landmarks are used when placing an internal jugular central venous catheter?
- Find SCM muscle, which splits into 2 heads (sternal head and a clavicular head), that form a triangle (bottom border is the clavicle) - Place the needle at the apex of this triangle at a 30 degree angle, and aim the needle toward the nipple - Also palpate the common carotid artery just medial to the needle, while you are inserting the needle to make sure you aren't puncturing it
313
A patient presents with a 1 cm, painless, mobile mass in her right parotid gland. You inform the patient that most tumors in the parotid gland are benign. What is the most common benign tumor of the salivary gland? What is a Warthin’s tumor? Which cranial nerve goes through the parotid gland?
- Pleomorphic adenoma is the most common benign salivary gland tumor - Warthin's tumor: benign, cystic salivary gland tumor; it has heterotrophic lymphoid tissue inside the salivary gland tissue which can form germinal centers, it looks like a lymph node trapped inside the parotid gland - CN VII (facial nerve, doesn't innervate it, just passes through)
314
What are the most common locations of lung cancer metastases?
Liver, bones, adrenal glands and brain
315
What are some of the functions of bile produced by hepatocytes and stored in the gallbladder? Which hormone is the most potent stimulator of gallbladder contractions?
- Bile emulsifies large fat particles and converts them into smaller fat particles that can then be degraded by lipase from the pancreas - Bile aids in the absorption of fat end-products - Bile is essential for the absorption of fat-soluble vitamins (ADEK) - Helps with excretion of bilirubin (in stool) - Helps with excretion of copper and cholesterol - CCK (cholecystokinin)
316
What is the characteristic fetal complication associated with lithium use in pregnancy? What other agents used to treat bipolar disorder can be teratogenic, and what are their corresponding fetal effects?
- Ebstein's Anomaly: Tricuspid leaflets displaced inferiorly (pushed down low into the RV), RV hypoplasia, and tricuspid regurgitation or stenosis - Carbamazepine IS TERATOGENIC (causes neural tube defects, craniofacial defects, IUGR, developmental delay, hypo plastic fingernails) - Valproate IS TERATOGENIC (causes neural tube defects, inhibits maternal folate absorption) - Aripiprazole/risperidone (can cause extrapyramidal symptoms)
317
Which anatomic structures are found in the retroperitoneum?
SAD PUCKER - suprarenal (adrenal) glands - aorta (and IVC) - duodenum - pancreas (except tail) - ureters - colon - kidneys - esophagus - rectum
318
What are the common causes of Erb-Duchenne palsy? Where is the brachial plexus insult with Erb- Duchenne palsy?
- Severe traction or tear of UPPER TRUNK of brachial plexus (C5 and C6 nerve roots) - Paralysis of abductors, lateral rotators, and supination by biceps - Arm hangs, "waiters tip" arm - Usually from shoulder trauma or traumatic delivery of baby
319
A central line is often placed in the subclavian vein to administer fluids and medications or to measure central venous pressure. What landmarks are used when placing a subclavian central line?
- Put thumb around middle of clavicle, and tip of your finger in jugular notch of manubrium - Insert needle medially, along the inferior surface of the clavicle, roughly aiming at the tip of your thumb
320
Metastasis to the brain commonly comes from which locations?
-Brain cancer comes from lung, breast, skin (melanoma), kidney (renal cell carcinoma), and GI tract
321
Metastasis to the liver commonly comes from which locations?
-Liver cancer comes from colon, stomach, pancreas, breast, and lung
322
Metastasis to the bone commonly comes from which locations?
-Bone cancer comes from prostate, thyroid, testes, breast, lung and kidney
323
Which glycogen storage disease is associated with severe hypoglycemia with elevated blood lactate?
Von Gierke disease (type 1 glycogen storage disease)
324
Which glycogen storage disease is associated with hypoglycemia without elevated blood lactate?
Cori disease (type III glycogen storage disease)
325
Which glycogen storage disease is associated with cardiomegaly?
``` Pompe disease (type II glycogen storage disease) Remember- pompe trashes the "pump" (heart) ```
326
Which glycogen storage disease is associated with myoglobinuria associated with exercise?
McArdle disease (type V glycogen storage disease)
327
What is the mechanism of organophosphate poisoning? What are the symptoms of cholinergic excess?
- Organophosphate inhibits acetylcholinesterase so Ach isn't degraded and stays in synapse, muscle keeps contracting - toxic build up of Ach - DUMBBELSS: diarrhea, urination (excessive), miosis, bronchospasm, bradycardia, excitation of skeletal muscle and CNS, lacrimation, salivation, sweating
328
What is the treatment for a pulmonary embolism?
- IV heparin or LMWH (Enoxaparin) - Both drugs activate antithrombin which stops clot formation - Usually don't use TPA (would maybe use this for ST elevation indicating an MI) - Lepirudin may be used if patient has heparin allergy
329
Which cancers can cause the paraneoplastic syndrome Lambert-Eaton syndrome?
LE syndrome- when antibodies bind to the voltage gated calcium channels on the presynaptic side of the neuromuscular junction - Calcium channels can't open, no depolarization occurs, and no Ach is released, so muscle can't contract (weakness) * *Small cell lung cancer** - Hodgkin lymphoma and malignant thymoma can also cause this
330
What is conductive hearing loss, and what are some causes?
-Sound isn't conducted to the cochlea (as opposed to sensory neuro hearing loss where the nerves themselves aren't working) CAUSES: -Wax build up in ear canal -Ear infection -Rupture of TM -Otosclerosis (abnormal growth of ossicles in middle ear)
331
What is the most common tumor of the urinary tract? What is the usual presenting complaint of a patient with this tumor? What substance exposures increase the risk of developing this tumor?
- Transitional cell carcinoma - Pt complain of painless hematuria - Risk Factors: SMOKING, aniline dyes, Phenacetin (not used anymore), and Cyclophosphamide
332
What pulmonary artery pressures indicate pulmonary hypertension?
(8-20 mmHg is normal) | > or equal to 25 mmHg at rest is pulmonary HTN
333
What conditions are associated with oligohydramnios, and what conditions are associated with polyhydramnios? What is the Potter sequence?
Oligohydramnios (less amniotic fluid than normal)- Placental insufficiency, bilateral renal agencies, posterior urethral values in males (conditions with decreased urine production) Polyhydramnios (more than normal fluid)- Esophageal or duodenal atresia, Anencephaly, Maternal diabetes -Potter Sequence: fetus has bilateral renal agenesis --> oligohydramnios --> multiple congenital malformations: "POTTER:" Pulmonary hypoplasia Oligohydramnios Twisted skin Twisted face Extremity/Limb deformities Renal agenesis
334
What is the MOA of Strychnine?
Glycine antagonist (glycine is an important inhibitory neurotransmitter in spinal cord, is when you give Strychnine and block glycine, you have muscle spasms and asphyxia--too much contraction)
335
What is the MOA of Tetanus toxin?
Blocks inhibitory function of glycine and GABA (another inhibitory CNS neurotransmitter) - Binds Renshaw cells (specific inhibitory cells that release glycine and GABA) - Overstimulation= tetanus and muscle spasms
336
What is the MOA of black widow spider toxin?
Causes excessive release of Ach | -Motor neurons dump all Ach into the synaptic cleft= muscle cramping and pain
337
What is the MOA of Botulinum toxin?
- Inhibitors release of Ach at NMJ | - flaccid paralysis (may be used to treat conditions of muscle spasms)
338
A 3-year-old girl presents with a fever of 102°F for the last three days. On the fourth day, the patient develops a red macular rash over the entire trunk, and her fever resolves abruptly. What viral infection is most likely in this case?
Roseola (caused by HHV 6) -Think of this when child has sudden high fever for a few days, fever goes away and rash begins (macular rash)
339
What is the difference between malingering and factitious disorder?
Malingering: illness faked for a specific secondary gain (person trying to get out of work, jury duty, or wants drugs) Factitious disorder: illness faked without secondary gain (enjoying the sick role and getting medical attention)
340
Which phase of drug metabolism do geriatric patients lose first? Which phase of drug metabolism makes a slightly polar metabolite by oxidation, reduction, or hydrolysis?
- Lose Phase 1 reactions of metabolism first - Phase 1 reactions: Oxidation, Reduction, Hydrolysis (all metabolized by cytochrome p450) - Elderly lose Phase 1 p450 reactions BEFORE they lose their phase 2 conjugation reactions
341
A patient complains of intense thirst and profuse urination. A diagnosis of diabetes insipidus is suspected after further testing. What would be the most likely urine specific gravity and serum osmolality findings in this patient?
-Diabetes insipidus- can't concentrate your urine (either your not making ADH or you're not responding to ADH) -Pts will have dilute uring -LOW urine osmolality -LOW specific gravity (less than 1.006) -High serum osmolarity (> 290) -If you can't concentrate your urine, you're going to lose a lot of free water
342
What are the essential amino acids?
``` -Must be supplied by diet (body can't make them) "PVT TIM HALL" -Phenylalanine -Valine -Threonine -Tryptophan -Isoleucine -Methionine -Histidine -Arginine (usually only in kids) -Leucine -Lysine ```
343
What medications are commonly used for the treatment of insomnia?
- Melatonin (OTC) - Antihistamine (Diphenhydramine, not good for long term) - Trazodone (antidepressant, increases REM sleep) - Tricyclic antidepressants (Amitriptyline, risk for arrhythmias, dangerous if OD) - Benzodiazepines like Temazepam or Lorazepam (can be addictive, only for short term use, less than 35 days) - Zolpidem (Ambien) and Zaleplon are very commonly used (act at benzodiazepine receptors, NOT as addictive, but can cause rebound insomnia when you stop) - Eszopiclone (lunesta- can be used long term) - Ramelteon (acts at melatonin receptors)
344
What mature structure arises from the bulbus cordis?
Right ventricle and outflow tracts of left and right ventricle
345
What mature structure arises from the left horn of sinus venous?
coronary sinus
346
What mature structure arises from the primitive atrium?
Fibrous (trabeculated) portions of left and right atria
347
What mature structure arises from the trunks arteriosus?
Ascending aorta and the pulmonary trunk
348
What mature structure arises from the primitive ventricle?
Fibrous (trabeculated) portions of the left and right ventricles
349
What mature structure arises from the right horn of sinus venosus?
Smooth part of right atrium
350
What mature structure arises from the right common and anterior cardinal veins?
SVC
351
Describe the rash associated with Rubella
Begins on the head and moves inferiorly
352
Describe the rash associated with Herpes zoster
Grouped vesicles on an erythematous base, in a unilateral dermatomal distribution
353
Describe the rash associated with HHV 6
Macular rash, appears several days after a high fever, usually seen in infants
354
Describe the rash associated with Parvovirus B19
"Slapped cheek" rash at first, then appears over the body in a reticular, lace-like pattern
355
Describe the rash associated with Coxsackievirus type A
Vesicular rash on the plans and soles, and ulcers in the oral mucosa
356
Describe the rash associated with Streptococcus pyogenes
Erythematous, sandpaper-like rash, accompanied by fever and sore throat
357
A 50-year-old man crashes on a motorcycle on the highway and sustains a right anterior hip dislocation and knee trauma. Now he cannot adduct his hip or plantarflex on that side. Which nerves are injured?
Obturator nerve (hip adduction) and tibial nerve (plantar flexion)
358
How much does the H&H change in a person that has acclimatized to a hypoxic environment for weeks?
Climatization process causes blood Hct to rise from 40-50 to about 60 and the Hbd to go from 15 to around 20
359
A 53-year-old man has just been diagnosed with peptic ulcer disease (PUD) visualized on endoscopy. Ranitidine and lansoprazole are the medications available on your hospital formulary for the treatment of PUD. Describe the different ways in which ranitidine and lansoprazole decrease parietal cell acid secretion. Why is ranitidine preferred over cimetidine? What other conditions can you treat with lansoprazole and ranitidine?
- Ranitidine blocks H2 histamine receptors - Normally, histamine binds to H2 receptor on parietal cell, and signals H+/K+ proton pump to start pumping H+ into the stomach lumen - So you still make some gastric acid, just not as much (when using Ranitidine) - Lanzoprazole is a PPI, these go right to the source and shut down the H/K ATPase pump (proton pump), completely stopping acid secretion - Ranitidine is preferred bc Cimetidine has lots of side effects (inhibits cP450, has anti-androgenic effects causing gynecomastia in men, it also crosses BBB and causes CNS effects like dizziness, headaches and confusion) - These drugs are also used to treat gastritis, GERD, and Zollinger Ellison syndrome
360
What are some extrapulmonary causes of restrictive lung disease?
- Idiopathic pulmonary fibrosis, Goodpastures disease, and some drugs are pulmonary causes of RSD - EXTRApulmonary causes: obesity (restricts lungs), scoliosis or sever kyphosis (curvature of spine restricts lungs), neuromuscular diseases like Myasthenia graves and Polio (weaken the muscles of respiration)
361
Wallenberg syndrome is an injury of the lateral medulla that presents with a constellation of neurologic symptoms including difficulty with swallowing (dysphagia), hoarseness, and difficulty with palate elevation. Which part of the lateral medulla is responsible for swallowing and palate elevation? What other cranial nerves can be involved with this region?
- Nucleus ambiguus (part of lateral medulla responsible for swallowing and palpate elevation), gives rise to efferent fibers of Vagus nerve - Other cranial nerves the receive input from Nucleus Ambiguus are the Glossopharyngeal nerve and the Spinal Accessory nerve
362
Which muscles compose the rotator cuff?
SItS - Supraspinatous - Infraspinatous - Teres minor - Subscapularis
363
How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state? What variables determine the half-life of a drug?
-It takes about 4-5 half lives for a drug to reach steady state -After 2 half lives, there is about 75% of drug present -After 3 half lives, there is about 87.5% of drug present -After 4 half lives, there is about 93.75% of drug present -Volume of distribution of drug and clearance of drug determine the half life EQUATION: half life= (0.7 x Vd) / clearance
364
Describe the anatomical layers of the penis
1. Outer dermis 2. Dartos fascia (muscle) 3. Deep (Buck's) fascia 4. Tunica Albugenia directly covers 3 cylinders of cavernous erectile tissue (2 dorsal corpora cavernosa and 1 ventral corpus spongiosum, and the urethra is within the spongiosum)
365
What is the mechanism of action of penicillin? Is it a bacteriostatic or bactericidal antibiotic?
- It inhibits bacterial cell wall synthesis (inhibits cross linking of peptidoglycan) - Bactericidal
366
What is the adult remnant of the female Gubernaculum?
Ovarian ligament and Round ligament of the uterus
367
What is the adult remnant of the Processes vaginalis (male)
Tunica vaginalis (serous covering of the testes)
368
What is the adult remnant of Foramen oval?
fossa ovalis
369
What is the adult remnant of notochord?
nucleus pulposus
370
A 37-year-old patient with refractory peptic ulcer disease undergoes an esophagogastric duodenoscopy (EGD). Biopsies of the duodenum reveal hypertrophied submucosal glands. What are these glands? What are Peyer’s patches? How can these structures help you identify the location from which a histological specimen was taken?
- Brunner's glands, secrete mucus to neutralize stomahc acid (located in duodenum) - Peyer's patches (lymph tissue of small intestine, in ileum, in the lamina propr. and submucosa) - Peyer's patches are part of MAL (mucosa associated lymphoid tissue)
371
A person eating fugu sashimi in Japan is at risk for what toxicity? What is the mechanism of this toxicity?
- Pufferfish, if not prepared correctly, may ingest Tetrodotoxin - Tetrodotoxin is a neurotoxin that binds to voltage gated sodium channels and prevents depolarization) - Can cause coma, respiratory arrest, CV collapse
372
You are performing a well-child examination on a 4-year-old girl. The patient was recently adopted after being removed from the biological mother for abandonment. What changes might you see in your evaluation? What are the effects seen in an infant when there is long-term deprivation of affection?
- Looking for signs of poor care, neglect and depression - Physically looking for malnutrition (short stature, low weight for age) and poor hygiene (dental caries and skin infections like scabies) - An infant may show poor muscle tone, poor language skills, poor socialization skills, lack of eye contact, weight loss, and failure to thrive
373
Which antifungal drugs cause gynecomastia and by what mechanism? Which diuretic drug causes gynecomastia and by what mechanism?
- Ketoconazole (antifungal): inhibits the first step of steroid synthesis (prevents conversion of cholesterol to pregnenolone via desmolase) - You get overall decreased testosterone production - Ketoconazole is also a weak androgen receptor antagonist - Spironolactone (diuretic), is an aldosterone antagonist and potassium sparing diuretic - Causes gynecomastia by increasing the conversion of testosterone to estradiol and BLOCKS testosterone synthesis *Some Drugs Cause Awesome Knockers (Spironolactone, Digitalis, Cimetidine, Alcohol, Keotconazole)
374
A 25-year-old woman presents to the clinic with severe pelvic pain that is always associated with menses. What diagnosis is characteristic of this type of pain and often results in infertility? What is the classic finding on the ovary that is associated with this diagnosis?
- Endometriosis (endometrial tissue outside of uterus) - Cyclical proliferation and shedding still occurs, irritating to surrounding tissues - In ovaries, may see blood filled cysts (chocolate cysts)
375
What are the early cyanotic heart diseases? What are the late cyanotic heart diseases?
Early (5 T's- use finger trick) 1. Truncus arteriosus (thumb- one giant vessel) 2. Transposition of the great vessels (cross pointer and middle finger) 3. Tricuspid atresia (3 fingers up) 4. Tetrology of Fallot (4 fingers) 5. Total anomalous pulmonary venous return (5 words, and total, all fingers) Late: - ASD - VSD - Patent ductus arteriosus (PDA)
376
For what conditions is hyperbaric oxygen therapy particularly helpful?
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377
What is the pressure in the potential spaces of the body including the pleural cavity, the joint spaces, and the pericardial cavity?
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378
If stroke volume determines cardiac output, and contractility determines stroke volume, what determines contractility?
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379
A 48-year-old man presents to your office with a persistent cough that has become bloody. Chest x- ray reveals a coin lesion within the lung parenchyma. Further workup reveals that the patient has the most common type of lung cancer in nonsmokers. Which cancer is this? What other lung cancers are not associated with smoking? Which lung cancers are associated with smoking, and where are they located, centrally or peripherally?
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380
How does standard deviation differ from standard error of the mean? Which one is used in calculating confidence intervals?
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381
Diagram the pathway by which the cochlea communicates a signal to the primary auditory cortex.
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382
Homocystinuria is one of the few diseases that can result in subluxation of the lens. What are the different causes of homocystinuria? How does the treatment differ for each?
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383
A 34-year-old obese white woman develops urinary retention after undergoing a laparoscopic cholecystectomy. Which cholinergic agonist can be used to treat post-op ileus and urinary retention? What conditions can be made worse by using cholinomimetic agents?
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384
A 20-year-old Italian woman complains of weakness and fatigue. A CBC reveals a microcytic, hypochromic anemia with a normal iron panel. Which type of thalassemia does this patient most likely have? What is the structure of HbH? What disease results in HbH production? What is the structure of Hb Bart’s? What disease results in Hb Bart’s production?
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385
A 23-year-old man undergoes a splenectomy due to splenic rupture from blunt abdominal trauma. What would you expect to find on this patient’s peripheral RBC smear after the splenectomy? Asplenic patients are susceptible to which encapsulated organisms? What vaccines for these encapsulated organisms should be given to asplenic patients?
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